Acute variceal bleeding portends poor outcomes in patients with acute-on-chronic liver failure: a propensity score matched study from the APASL ACLF Research Consortium (AARC).

Autor: Sharma S; Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India., Agarwal S; Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India., Saraya A; Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, 110029, India. ansaraya@yahoo.com., Choudhury A; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India., Mahtab MA; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh., Alam MS; Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh., Saigal S; Department of Hepatology, Medanta The Medicity, Gurgaon, India., Kim DJ; Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea., Eapen CE; Department of Hepatology, Christan Medical College, Vellore, India., Goel A; Department of Hepatology, Christan Medical College, Vellore, India., Ning Q; Department of Medicine, Tongji Hospital, Tongji Medical College, Wuhan, China., Devarbhavi H; Department of Hepatology, St Johns Medical College, Bangalore, India., Singh V; 9Department of Hepatology, PGIMER, Chandigarh, India., Shukla A; LTMMC, Mumbai, India., Hamid S; Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan., Hu J; Department of Medicine, Military Hospital, Beijing, 302, China., Tan SS; Department of Medicine, Hospital Selayang, Bata Cabs, Selangor, Malaysia., Arora A; Department of Gastroenterology, Sir Ganga Ram Hospital and GRIPMER, Delhi, India., Sahu MK; Department of Hepatology, IMS and SUM Hospital, Bhubaneshwar, Odisha, India., Rela M; Department of Liver Transplant Surgery, Dr. Rela Institute and Medical Centre, Chennai, India., Jothimani D; Department of Liver Transplant Surgery, Dr. Rela Institute and Medical Centre, Chennai, India., Rao PN; Asian Institute of Gastroenterology, Hyderabad, India., Kulkarni A; Asian Institute of Gastroenterology, Hyderabad, India., Ghaznian H; Department of Hepatology, Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia., Lee GH; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Zhongping D; Translational Hepatology Institute Capital Medical University, Beijing You' an Hospital, Beijing, China., Sood A; Department of Gastroenterology, Dayanand Medical College, Ludhiana, India., Goyal O; Department of Gastroenterology, Dayanand Medical College, Ludhiana, India., Lesmana LA; Department of Medicine, Medistra Hospital, Jakarta, Indonesia., Lesmana RC; Department of Medicine, Medistra Hospital, Jakarta, Indonesia., Treeprasertsuk S; Department of Medicine, Chulalongkorn University, Bangkok, Thailand., Yuemin N; Hebei Medical University, Shijiazhuang, China., Shah S; Department of Hepatology, Global Hospital, Mumbai, India., Tao H; Tianjin Institute of Hepatobiliary Disease, Tianjin, China., Dayal VM; IGIMS, Patna, India., Shaojie X; Medical School of Chinese PLA, Beijing, China., Karim F; Department of Hepatology, Sir Salimullah Medical College, Dhaka, Bangladesh., Abbas Z; Department of Medicine, Ziauddin University Hospital, Karachi, Pakistan., Sollano JD; Department of Medicine, University of Santo Tomas, Manila, Philippines., Kalista KF; Division of Hepetobiliary, Cipto Mangunkusuamo Hospital, University of Indonesia, Jakarta, Indonesia., Shreshtha A; Department of Hepatology, Foundation Nepal, Sitapaila Height, Kathmandu, Nepal., Payawal D; Department of Medicine, Cardinal Santos Medical Center, Metro Manila, Philippines., Omata M; Department of Hepatology, Yamanashi Central and Kita Hospitals, University of Tokyo, Tokyo, Japan., Sarin SK; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com.
Jazyk: angličtina
Zdroj: Hepatology international [Hepatol Int] 2022 Oct; Vol. 16 (5), pp. 1234-1243. Date of Electronic Publication: 2022 Jul 18.
DOI: 10.1007/s12072-022-10372-1
Abstrakt: Background and Aims: Limited data exist regarding outcomes of acute variceal bleeding (AVB) in patients with acute-on-chronic liver failure (ACLF), especially in those with hepatic failure. We evaluated the outcomes of AVB in patients with ACLF in a multinational cohort of APASL ACLF Research Consortium (AARC).
Methods: Prospectively maintained data from AARC database on patients with ACLF who developed AVB (ACLF-AVB) was analysed. This data included demographic profile, severity of liver disease, and rebleeding and mortality in 6 weeks. These outcomes were compared with a propensity score matched (PSM) cohort of ACLF matched for severity of liver disease (MELD, AARC score) without AVB (ACLF without AVB).
Results: Of the 4434 ACLF patients, the outcomes in ACLF-AVB (n = 72) [mean age-46 ± 10.4 years, 93% males, 66% with alcoholic liver disease, 65% with alcoholic hepatitis, AARC score: 10.1 ± 2.2, MELD score: 34 (IQR: 27-40)] were compared with a PSM cohort selected in a ratio of 1:2 (n = 143) [mean age-44.9 ± 12.5 years, 82.5% males, 48% alcoholic liver disease, 55.7% alcoholic hepatitis, AARC score: 9.4 ± 1.5, MELD score: 32 (IQR: 24-40)] of ACLF-without AVB. Despite PSM, ACLF patients with AVB had a higher baseline HVPG than without AVB (25.00 [IQR: 23.00-28.00] vs. 17.00 [15.00-21.75] mmHg; p = 0.045). The 6-week mortality in ACLF patients with or without AVB was 70.8% and 53.8%, respectively (p = 0.025). The 6-week rebleeding rate was 23% in ACLF-AVB. Presence of ascites [hazard ratio (HR) 2.2 (95% CI 1.03-9.8), p = 0.026], AVB [HR 1.9 (95% CI 1.2-2.5, p = 0.03)], and MELD score [HR 1.7 (95% CI 1.1-2.1), p = 0.001] independently predicted mortality in the overall ACLF cohort.
Conclusion: Development of AVB confers poor outcomes in patients with ACLF with a high 6-week mortality. Elevated HVPG at baseline represents a potential risk factor for future AVB in ACLF.
(© 2022. Asian Pacific Association for the Study of the Liver.)
Databáze: MEDLINE
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